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7. CP - Kidney and Urinary Tract Disease > (33) Urogenital Pathology > Flashcards

(33) Urogenital Pathology Flashcards

1
Q

What is nodular prostatic hyperplasia also know as?

A

Benign prostatic hyperplasia (BPH)

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2
Q

What is nodular prostatic hyperplasia/BPH?

A

Enlargement of the prostate - overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area

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3
Q

What are the lower urinary tract symptoms (LUTS) of BPH?

A
  • urgency
  • difficulty starting urination
  • diminished stream size and force
  • increased frequency
  • incomplete bladder emptying
  • nocturia
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4
Q

What causes the LUTS in BPH?

A

Interference with the muscular sphincteric function and by obstruction of urine flow through the prostatic urethra

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5
Q

The normal prostate contains several distinct regions. Name 4 regions

A
  • central zone
  • peripheral zone
  • transitional zone
  • periurethral zone
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6
Q

Where do most carcinomas of the prostate arise from?

A

The peripheral glands of the organ - may be palpable on digital examination of rectum

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7
Q

In contrast to carcinomas, where does nodular prostatic hyperplasia arise?

A

More centrally situated glands - more likely to produce urinary obstruction earlier than carcinoma

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8
Q

Development of nodular hyperplasia includes what 3 pathologic changes?

A
  • nodule formation
  • diffuse enlargement of the transition zone and periurethral tissue
  • enlargement of nodules
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9
Q

Which feature of nodular hyperplasia is predominant among under 70s

A

Diffuse enlargement of transition zone and periurethral tissue

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10
Q

Which feature of nodular hyperplasia is predominant among older men?

A

Nodule formation and enlargement of nodules

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11
Q

Describe 2 histologically different types of nodules you can get in nodular hyperplasia

A
  • pure stromal nodule (uniform and circumscribed with stromal fibroblasts and scattered lymphocytes)
  • mixed epithelial-stromal nodule
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12
Q

What is the aetiology behind BPH?

A
  • impaired cell death = accumulation of senescent cells in prostate
  • androgens (mainly DHT) involved in BPH can increase cellular proliferation and inhibit cell death
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13
Q

95% of prostatic malignancies are what type?

A

Prostatic adenocarcinoma

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14
Q

At what age does the incidence of prostatic adenocarcinoma rise quickly?

A

40 years

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15
Q

What is the different between autopsy-based prevalence and clinical incidence of prostatic adenocarcinoma?

A

Autopsy studies of prostates from men without clinical evidence of cancer have sown a very high level of latent cancer

autopsy > clinical

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16
Q

The incidence of prostatic adenocarcinoma is much higher in men of what ancestry?

A

African (100 per 100,000)

compared to European (70.1 per 100,000)

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17
Q

How is cancer of the prostate treated?

A
  • surgery
  • radiation
  • hormonal manipulations
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18
Q

How long can those receiving treatment for prostate cancer expect to live?

A

More than 90% of patients who receive such therapy can expect to live for 15 years

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19
Q

What is the most common treatment for clinically localised prostate cancer?

A

Radical prostatectomy

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20
Q

What is the prognosis following radical prostatectomy based on?

A
  • pathologic stage
  • margin status
  • Gleason grade
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21
Q

What are the alternative treatments for localised prostate cancer? (other than radical prostatectomy)

A
  • external-beam radiation therapy

- interstitial radiation therapy (brachytherapy)

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22
Q

External-beam radiation therapy is also used to treat prostate cancer that is what?

A

Too locally advanced to be cured by surgery

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23
Q

What are the risk factors involved in carcinoma of the prostate?

A
  • age
  • race
  • family history
  • hormone levels (androgens)
  • environmental influence eg. increased consumption of fats
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24
Q

Which hormones play a big part in prostate cancer?

A

Androgens

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25
Q

What role do androgens play in prostate cancer?

A

Maintain growth and survival of prostate cancer cells

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26
Q

How can the effects of androgens in prostate cancer be seen?

A

In the therapeutic effect of castration or treatment with anti-androgens, which usually induce disease regression

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27
Q

How does family history (inherited polymorphisms) affect risk of prostate cancer?

A
  • 1 first-degree relative with prostate cancer = 2x the risk
  • 2 first-degree relatives = 5x the risk

Strong family history also = develop disease at earlier age

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28
Q

Men with germline mutations of which gene have a 20-fold increase in risk of prostate cancer?

A

tumour suppressor BRCA2 gener

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29
Q

What is currently the only accepted grading system for prostate carcinoma?

A

Gleason scoring system (recommended by WHO)

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30
Q

What are the 5 stages of prostate cancer according to Gleason scoring system?

A
  1. Small, uniform glands. Well differentiated
  2. More stroma between glands
  3. Distinctly infiltrative margins. Moderately differentiated
  4. Irregular masses of neoplastic cells
  5. Only occasional gland formation. Poorly differentiated/anaplastic
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31
Q

Why might screening for prostate cancer not be beneficial?

A
  • role of PSA - false positives and false negatives
  • complications of treatment (impotence, incontinence etc)
  • unnecessary treatments
  • limited benefits
  • consideration in high risk groups
  • reduced mortality vs. risks of over treatment
32
Q

Who is the incidence of testicular tumours highest amongst globally?

A

Among men of northern European ancestry

Lowest among men of Asian and African descent

33
Q

What pre-existing medical conditions have been associated with development of testicular germ cell tumours (TGCT)?

A
  • prior TGCT in the contralateral testicle
  • cryptorchidism
  • impaired spermatogenesis
  • inguinal hernia
  • hydrocele
  • disorders of sex development
  • prior testicular biopsy
  • atopy
  • testicular atrophy
34
Q

What is cryptorchidism?

A

The absence of one or both testes from the scrotum. It is the most common birth defect of the male genitalia

35
Q

Name 2 types of testicular cancer

A
  • seminoma

- teratoma

36
Q

At what age is seminoma most common?

A

35-45 yrs

  • uncommon in men >50
  • rare in children
37
Q

At what age is teratoma most common?

A

In the 1st and 2nd decades of life

38
Q

Describe the typical clinical presentation of seminoma

A
  • testicular enlargement
  • with or without pain
  • metastases
  • some patients have no symptoms
  • rare symtoms = gynaecomastia, exophthalmos, infertility
39
Q

What is the typical clinical presentation of teratoma?

A
  • gradual testicular swelling

- with or without pain

40
Q

Can mature teratoma be benign?

A

Mature teratoma is almost always benign in prepubertal patients

However, it can pursue an aggressive clinical course after puberty i.e. metastasis

41
Q

Immature teratoma is a common component of what?

A

NSGCTs (non-seminomatous germ cell tumours)

Teratoma in its pure form is very rare

42
Q

What are the tumour markers in seminoma?

A
  • elevated serum PLAP (40%)

- elevated hCG (10%) - cause of gynaecomastia

43
Q

What are the tumour markers in teratoma?

A

Purely teratomatous tissues do not secrete tumour markers

44
Q

Describe the macroscopic appearance of seminoma

A
  • well-demarcated
  • cream-coloured
  • homogeneous
  • coarsely lobulated
45
Q

Describe the microscopic appearance of teratoma

A
  • monotonous polygonal cells with mostly clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma
46
Q

Describe the microscopic appearance of teratoma

A
  • mixture of ectoderm, endoderm, and mesoderm
47
Q

Name 7 inflammatory conditions of the testis

A
  • acute and chronic epididymoorchitis
  • idiopathic granulomatous orchitis
  • sarcoidosis of the testis
  • malakoplakia of testis
  • myofibroblastic pseudo tumour of testis
  • sperm granuloma
  • tuberculous orchitis
48
Q

What do you seen on histology in acute/chronic epididymoorchitis?

A
  • ghostly outlines of infarcted seminiferous tubules

- surrounded by purulent exudate containing neutrophils and other inflammatory cells

49
Q

Idiopathic granulomatous orchitis typically presents in older adults, with associated symptoms of what?

A
  • UTI
  • trauma
  • flu-like illness
50
Q

What happens to the testis in idiopathic granulomatous orchitis?

A

Becomes swollen, painful and tender initially but later may have a residual mass indistinguishable from a neoplasm, prompting orchiectomy

51
Q

What causes the granulomatous appearance in idiopathic granulomatous orchitis?

A

No granulomas present but the interstitial and intratubular aggregation of epithelioid histiocytes, lymphocytes and plasma cells imparts a granulomatous appearance

52
Q

Sarcoidosis can affect the testis. What may it mimic?

A

Malignancy, particularly if accompanied by radiologic pulmonary abnormalities

53
Q

What may you see on histology in sarcoidosis of the testis?

A
  • non-nectrotising granulomas involving testicular parenchyma
  • special stains for fungal organisms and acid-fast bacilli are negative
54
Q

What may malakoplakia affect?

A

Only the testis, or less commonly, both the testis and the epididymis

55
Q

What does malakoplakia of the testis result in the formation of?

A

Soft yellow, tan, or brown nodules that replace normal testicular parenchyma

56
Q

What is seen on histology in malakoplakia of the testis?

A

The tubules and interstitium are extensively infiltrated by large histiocytes that have abundant eosinophilic granular cytoplasm

57
Q

What are the histiocytes called in malakoplakia?

A

von Hansemann histiocytes

58
Q

What is myofibroblastic pseudotumour of testis?

A

An atypical inflammatory and myofibroblastic reaction with fasciitis-like large cells

Features of malignancy are absent

A benign reactive and proliferative process of uncertain aetiology

59
Q

What is a sperm granuloma?

A

An exuberant foreign body giant cell reaction to extravasated sperm

60
Q

How common is sperm granuloma?

A

Occurs in up to 42% of patients after vasectomy

2.5% of routine autopsies

61
Q

What are signs and symptoms of sperm granuloma?

A

May have no symptoms

Often present with history of pain and swelling of the upper pole of the epididymis, spermatic cord, and rarely, the testis

Others have a history of trauma, epididymiditis and orchitis

62
Q

Where is the reservoir for tuberculous involvement in the male genital tract?

A

The epididymis

With secondary testicular involvement and other local sites of involvement in about 80% of cases

63
Q

How many cases of renal tuberculosis are accompanied by epididymis infection?

A

40%

64
Q

How do patients usually present with tuberculous orchitis?

A

With painless scrotal swelling

Other signs include unilateral or bilateral mass, infertility, and scrotal fistula

65
Q

What kind of inflammation do you get in tuberculous orchitis?

A

Caseating granulomatous inflammation is prominent, with fibrous thickening and enlargement of the epididymis and adjacent structures

66
Q

What makes up 25% of cases of empty scrotum?

A

Cryptorchidism

67
Q

In, cryptorchidism, where are the testes most frequently found?

A

In the inguinal canal or upper scrotum; arrest within the abdomen is less frequent

68
Q

On which side is cryptorchidism more common?

A

Slightly more common on the right; 18% are bilateral

69
Q

What is the causes of congenital cryptorchidism?

A

Anomalies in anatomic development or hormonal mechanisms involved in testicular descent

70
Q

What are the causes of acquired cryptorchidism?

A

Postoperative or spontaneous ascent

  • inability of spermatic vessels to grow adequately
  • anomalous insertion of the gubernaculum
  • failure in reabsorption of the vaginal process
  • failure in postnatal elongation of the spermatic cord
71
Q

What are the potential complications associated with cryptorchidism?

A
  • testicular atrophy
  • infertility
  • carcinoma (TGCTs)
72
Q

What is hypogonadism?

A

Reduction or absence of hormone secretion or other physiological activity of the gonads (testes or ovaries).

73
Q

What are the primary causes of hypogonadism/testicular failure?

A
  • undescended testis
  • Klinefelter syndrome
  • haemochromatosis
  • mumps
  • orchitis
  • trauma
  • CF
  • testicular torsion
  • variocele
74
Q

What are the secondary cause of hypogonadism/testicular failure?

A
  • pituitary failure
  • drugs (glucocorticoids, ketoconazole, chemotherapy, opioids)
  • obesity
  • aging
75
Q

What is Klinefelter syndrome?

A

Set of symptoms that arise from 2 or more X chromosomes in males

47 XXY

76
Q

What is variocele?

A

An abnormal enlargement of the pampiniform venous plexus in the scrotum

7. CP - Kidney and Urinary Tract Disease (5 decks)

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